Browsing by Author "Kafle, D"
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Publication Adjunctive Orthodontic Treatment with Lingual Orthodontic System(Kathmandu University, 2011) Kafle, D; Humagain, M; Upadhaya, CABSTRACT The lingual orthodontic therapy though started in 1972, could not be popular till the beginning of 1990. In Nepal it does not have a history of more than a year. It is started in Dhulikhel Hospital for the first time in Nepal. Usually orthodontic therapy is meant for putting braces on the labial surface of the teeth which is called labial orthodontic system. Lingual orthodontic system is a purely invisible kind of orthodontic therapy in which braces are placed behind the teeth. The advantages of lingual orthodontic therapy are: invisibility, better biomechanics and improved patient compliance. On the other hand it is difficult to master and costlier than labial orthodontics. We have presented six adjunctive orthodontic cases treated by lingual system with the same end result comparable to labial orthodontic system. KEY WORDS invisible, labial ,lingual, orthodonticsPublication Anticipated Pain and Pain Experience Among Orthodontic Patients: Is there any Difference?(Kathmandu University, 2012) Kafle, D; Rajbhandari, AABSTRACT Background Orthodontic treatment is taken as a painful procedure by most of the patients. The pain can be experienced during different procedures like separator placement, banding, bonding, extraction as well as arch wire activation and debonding. There are very few studies done on the anticipated pain and pain experienced among mentioned orthodontic procedures. Objectives To compare the anticipated pain and pain experience among the patients going for comprehensive orthodontic treatment. Methods Total 45 patients going for comprehensive orthodontic therapy are enrolled into the study. They are given a 100mm Visual Analogue Scale (VAS) for pain. The anticipated pain as well as perceived pain after different orthodontic procedures are recorded on the VAS by patients and returned back to orthodontic office. The data are analyzed by SPSS 16.00 software by paired and independent t-test for the statistical significance. Results The result showed that there is significant difference between the anticipated pain before orthodontic treatment and the pain experienced following orthodontic treatment. It also showed that perception of pain between two sexes is significantly different. The comparison of anticipated pain among male and female does not show any significant difference, however the pain felt after separator placement as well as after orthodontic bonding is significantly different in two sexes. Conclusion The level of anticipated pain before orthodontic treatment is higher than the real pain experienced after orthodontic procedures. So it is better to counsel and explain the patients about the orthodontic treatment and procedures. KEY WORDS Anticipated Pain, Orthodontic, Visual analogue scalePublication Correlation of Pelvic Parameters with Isthmic Spondylolisthesis(Kathmandu University, 2021) Shrestha, S; Lakhey, RB; Paudel, S; Kafle, D; Pokharel, RABSTRACT Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it. Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis. Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group. Result In control group, the pelvic incidence was 50.44±4.78o, the sacral slope was 34.38±6.79o, the pelvic tilt was 15.97±5.31o, and the lumbar lordosis was 46.76±6.78o. In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79o, the sacral slope was 40.40±6.91o, the pelvic tilt was 20.63±7.51o, and the lumbar lordosis was 57.31±7.11o. The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p < 0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52o, II =62o and III 72.5o). Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip. KEY WORDS Isthmic spondylolisthesis, Lumbar lordosis, Pelvic incidence, Pelvic tilt, Sacral slopePublication Gender Based Comparison of Gingival Zenith Esthetics(Kathmandu University, 2016) Humagain, M; Rokaya, D; Srii, R; Dixit, S; Kafle, DABSTRACT Background The size, proportion and gingival zenith position of maxillary anterior teeth plays in the anterior teeth esthetics. Objective To compare the gingival zenith positions and levels between male and female in right and left side as an esthetic parameter. Method Impression of the maxillary arch was made in each participant with irreversible hydrocolloid, and dental cast was made with dental stone type IV. Two clinical parameters were evaluated: (1) the gingival zenith position (GZP) from the vertical bisected midline along the long axis of each individual maxillary anterior tooth; and (2) the gingival zenith level (GZL) of the lateral incisors in an apical-coronal direction relative to the gingival line joining the tangents of the GZP of the adjacent central incisor and canine teeth under healthy conditions. Statistical analyses were conducted using SPSS with the level of significance (α) = 0.05. Descriptive statistics was done and Independent t-test was used to compare the GZP and GZL between male and female. Result In male, the gingival zenith position for right side central, lateral and canine were 1.05 mm, 0.57 mm and 0.14 mm, and in left side were 1.02 mm, 0.53 mm, 0.15 mm. In female, the gingival zenith position for right side central, lateral and canine were 0.99 mm, 0.48 mm and 0.15 mm, and in left side were 0.94 mm, 0.44 mm and 0.14 mm. The gingival zenith position was significantly different between male and female for both lateral incisors. In addition, significantly different was found for the lateral incisor between right and left side. In male, the gingival zenith level of right and left lateral incisors 0.74 mm and 0.71 mm. In female, the gingival zenith level of right and left lateral incisors 0.76 mm and 0.72 mm. No significant difference was found between male and female for the gingival zenith level of right and left lateral incisors. Conclusion The GZP and GZL obtained from this study can be clinically applied to reestablish the GZP of the maxillary anterior teeth during periodontal surgery; crown lengthening or root coverage procedures. KEY WORDS Esthetics, gingiva, maxilla, zenithPublication Orthognathic Surgery for the Correction of Severe Skeletal Class III Malocclusion(Kathmandu University, 2016) Kafle, D; Upadhayaya, C; Chaurasia, N; Agarwal, AABSTRACT Skeletal Malocclusions results from the abnormal position of maxilla and mandible in relation with cranial base. These types of malocclusion are commonly treated by orthodontic teeth movement known as camouflage orthodontics. However severe skeletal malocclusions cannot be treated by orthodontics alone. Such cases need surgical intervention to align the position of the jaw along with orthodontic correction. This procedure is commonly known as Orthognathic Surgery. Orthognathic Surgery dates back to early eighteenth century but became popular on mid twentieth century. Though the prevalence of skeletal malocclusion is more than 1% the treatment facility was not available in Nepal till 2012. Here we present a case of Skeletal Class III malocclusion treated at Dhulikhel Hospital, Kathmandu University Hospital. For this case, double jaw surgery was performed by le-Fort I osteotomy and Bilateral Sagital Split Osteotomy. Orthognathic surgery has been routinely performed at this centre since then. KEY WORDS Bilateral Sagittal split Osteotomy, Le-fort I Osteotomy, orthognathic surgery, skeletal malocclusionPublication Radiographic Assessment of Occurrence of Pulp Stones in Molars of Selected Adult Nepalese Populations at Tertiary Care Center(Kathmandu University, 2021) Acharya, N; Chakradhar, A; Kafle, DABSTRACT Background Pulp stones or “denticles” are a frequent finding in coronal and radicular pulp of primary and permanent dentition. These discrete calcified bodies can be seen in a healthy, diseased and sometimes even in an unerupted tooth. These calcifications are mostly present in molars as free, attached or embedded to dentine of pulp chamber or root canals. Objective To determine the occurrence of pulp stones in molars of selected adult Nepalese population using radiographs and assess the association of its occurrence gender and arch wise. Method A descriptive cross-sectional study was performed using orthopantomogram of total 380 patients (190 male and 190 females) of age group ranging from 16-30 years by convenience sampling. Data were collected through the examination of both hard and soft copies of radiographs under magnification. Pulp stones were scored as present or absent and their association with gender and dental arch were recorded. Descriptive statistics and chi square test was performed to see the prevalence and to compare the occurrence of pulp stone respectively. Result Out of 380 radiographic samples, pulp stones were present in 41.05% of the samples. The occurrence of pulp stones were found to be higher in females than in males, although the difference was not statistically significant (p=0.060).The total number of teeth with pulp stones was 238 and 61 in maxillary and mandibular arches respectively, with statistically significant difference (p<0.001). Conclusion The overall occurrence of pulp stone was found to be 41.05%. It was observed more in females (45.78%) than in males (37%) and more frequently located in maxillary molars (29.2%) than in mandibular molars (8.2%). KEY WORDS Denticles, Molars, Nepalese population, Prevalence, Pulp stonesPublication Retrospective Study to Determine Stability of Mandibular Setback Surgery using Bilateral Sagittal Split Osteotomy Technique(Kathmandu University, 2016) Upadhyaya, C; Chaurasian, NK; Kafle, DABSTRACT Background Bilateral sagittal split osteototomy of mandible is one of the most commonly performed orthognathic surgical procedure performed in the mandible. According to hierarchy of stability, mandibular setback procedure is considered to be relatively unstable procedure and chances of relapse are higher. Objective We conducted this study to determine the skeletal stability of mandibular setback procedure using bilateral sagittal split osteotomy technique in Nepalese population. Method Lateral cephalograms of 14 patients who underwent mandibular setback using bilateral saggital split osteotomy were taken pre-operatively (P1), immediate post- operatively (P2) and eight months to one year post-operatively (P3). Cephalometric tracing was done for all the cephalograms. Various parameters of Burstone’s hard and soft tissue, Steiner’s and McNamara analysis were used in the study to determine angular and linear changes following surgery. After tracing the cephalograms, changes between P1- P2, P1-P3 and P2-P3 were calculated. Mean difference in changes between P1-P2, P1-P3 and P2-P3 were compared using paired t test. P value less than 0.05 was considered to be significant. Data analysis was done using SPSS software version 20. Result Mean setback at Pogonion was 3.03 mm whereas at point B were 4.64 mm. Relapse at Pogonion was 0.03 mm and relapse at point B were 0.02 mm. Mean change in point A-Nasion-point B angle was 5.1 degrees whereas mean changes in NA-Pogonion angle were 4.69 degrees. Conclusion There were significant changes in angular as well as horizontal parameters at P2 but there were no significant changes in those parameters at P3. This is a preliminary study that we have carried out at our institution with smaller sample size thus we recommend a study with larger sample size and long term follow up. KEY WORDS Bilateral sagittal split osteotomy, mandibular setback, stabilityPublication The Need of Endodontic Therapy among Patients Attending Tertiary Care Center in Central Nepal(Kathmandu University, 2022) Acharya, N; Humagain, R; Dahal, S; Kafle, DABSTRACT Background Dental caries is considered as the most prevalent oral disease in Nepalese population that frequently needs endodontic therapy or root canal treatment (RCT). Pulp infection is one of the most common sequels of dental caries which when left untreated leads to pulpal necrosis and peri-radicular diseases. Patients usually reports to the dental hospital after there is pain, sensitivity, swelling or fracture of the tooth structure which usually impedes their normal routine of daily life. RCT is one of the efficacious therapeutic procedures that can save the teeth retaining its aesthetics and function. Objective To determine the need of RCT among patients attending Tertiary Care Hospital. Method A cross-sectional epidemiological study was conducted in the Department of Conservative Dentistry and Endodontics over the period of one year from April 2019 to April 2020. Ethical approval was taken from the Institutional Review Committee Kathmandu University School of Medical Sciences. In total, 7566 records of the patients that needed endodontic therapy and other treatments were collected and the need of endodontic therapy versus other treatments were assessed. The data obtained were analyzed using the SPSS version 20. The association between various patient-related variables were calculated by chi square test and mean, standard deviation, frequency and percentage were calculated using descriptive statistics. P value was set at < 0.05 for statistical significance. Result Among the total study population, (n=7566), the mean age was 34.97±14.34 years among which 4387 (58%) were females and 3179 (42%) were males. The type of treatment required by the study participants were significantly associated with age and sex (p < 0.001) and p < 0.001, respectively). Conclusion The findings of this study concluded that there was an increased need for endodontic therapy among patients visiting the department compared to other treatments. There was a significant association between gender and age showing females and elderly patients in greater need for endodontic therapy. KEY WORDS Endodontic therapy, Epidemiology, Periapical periodontitis, Pulpal pain, Treatment need